Primer registro de angioembolización de arterias hipogástricas en contexto de trauma pélvico en Uruguay / First report of hypogastric arteries angioembolization within the context of pelvic trauma in Uruguay / Primeiro registro de angioembolização de artérias hipogástricas no contexto de traumatismo pélvico no Uruguai

Resumen: El trauma pélvico grave es una situación de extrema gravedad con alta mortalidad, siendo la principal causa de muerte el shock hemorrágico persistente, secundario a varias fuentes de sangrado óseas, viscerales y principalmente venosas y arteriales. Las medidas iniciales van dirigidas a disminuir el volumen de la cavidad pélvica y la reposición hemostática. En los últimos años evidencia creciente respalda la utilización de la angioembolización en el manejo de estos pacientes. Presentamos a través de un caso clínico el primer reporte en Uruguay de angioembolización no selectiva de ambas arterias hipogástricas en el manejo del trauma pélvico grave. Discutiremos a través de un caso clínico la fisiopatología del trauma pélvico grave y principalmente las indicaciones, resultados y complicaciones de la angioembolización.

Summary: Pelvic trauma is an extremely severe condition accounting for high mortality rates, and is the first cause of death in persistent hemorrhagic shock, secondary to several sources of bleeding, such as bone, viscera and mainly veins and arteries. Initial measures aim to reduce the volume of the pelvic cavity and to restore hemostasis. In recent years, growing evidence supports the use of angioembolization in the handling of these patients. The study presents, through a clinical case, the first report in Uruguay of non-selective angioembolization of both hypogastric arteries in the handling of severe pelvic trauma. We will discuss the pathophysiology of severe pelvic trauma through a clinical case, mainly in terms of indications, results and complications of angioembolization.

Resumo: O traumatismo pélvico grave é uma situação extremamente complicada com alta mortalidade, sendo a principal causa de morte o choque hemorrágico persistente, secundário a várias fontes de sangramento ósseas, viscerais e principalmente venosas e arteriais. As medidas iniciais têm como objetivo diminuir o volume da cavidade pélvica e a reposição hemostática. Nos últimos anos, evidências crescentes apoiam o uso da angioembolização no gerenciamento desses pacientes. Apresentamos um caso clínico com o primeiro registro no Uruguai de angioembolização não seletiva de ambas as artérias hipogástricas no manejo de traumas pélvicos graves. Discutiremos a fisiopatologia do traumatismo pélvico grave e principalmente as indicações, resultados e complicações da angioembolização.

Fractura de pelvis inestable. Estudio de cohorte longitudinal / Unstable pelvic Fractures. A Cohort Study

Introducción No hay consenso sobre el paradigma de tratamiento óptimo para pacientes que se presentan con fractura de pelvis inestable y más si se asocia a inestabilidad hemodinámica. El estudio se realizó para determinar la experiencia en el manejo de pacientes con una fractura inestable de la pelvis, con o sin inestabilidad hemodinámica, en un centro de referencia de trauma de Medellín, Colombia, como un paso inicial para avanzar protocolos adaptados a las necesidades particulares de nuestra población. Materiales & Métodos Se realizó un estudio retrospectivo, observacional que incluyó pacientes con fractura pélvica por traumatismo. Se recogieron datos demográficos, signos vitales de admisión, presencia de shock al ingreso (según escala ATLS), método de control de hemorragias, requerimiento de transfusión y mortalidad global. Se realizó análisis de un subgrupo de pacientes que se presentaron con signos de Shock hemodinámica grave asociado, definido como ATLS III- IV al ingreso y requerimiento de hemoderivados de más de 8UI en las primeras 48 horas. Resultados Un total de 567 pacientes con fractura pélvica de cualquier tipo, entre enero de 2011 y diciembre de 2018, identificados en las bases de datos de la institución, de los cuales 149 pacientes presentaron un patrón de fractura inestable de la pelvis (FIP). El 68.1% de los pacientes eran varones, con una edad media de 34 RIQ; 30 años y una puntuación de gravedad de la lesión (ISS) de 34 RIQ: 20. La mortalidad hospitalaria fue del 13.3%. La angioembolización y la colocación de fijadores externos fueron el método más común de control de hemorragias utilizado. Un total de 37 pacientes (27%) se sometieron intervención para el control de la hemorragia en las primeras 48 horas. Hubo 37 pacientes con fractura pélvica admitidos en estado de shock grave o requerimiento de más de 8U hemoderivados, 17 pacientes requirieron intervención en la pelvis, únicas o combinadas. La mortalidad calculada para estos pacientes fué de 32%. Discusión Los pacientes con FPI admitidos en nuestra institución tienen una alta mortalidad y es aún mayor en los pacientes quienes se presentan con Shock grave. Se utilizaron varios métodos para el control de la hemorragia de forma semejante a las indicadas en la literatura actual. Requerimos un esfuerzo institucional sostenido para tratar las fracturas pélvicas y disminuir la mortalidad de nuestros pacientes y conocer nuestra población nos permite orientar las estrategias de manejo.

Background There is no consensus about treatment for patients with an unstable pelvic fracture and even less when hemodynamic instability is associated with. Study was conducted to determine the outcome in the management of patients with an unstable fracture of the pelvis, with or without hemodynamic instability, in a trauma referral center in Medellín, Colombia. Methods A retrospective, longitudinal cohort study was conducted including patients with pelvic fracture due to trauma. Demographic data, vital signs on admission, presence of hemodynamic shock on admission (according to the ATLS scale), method of bleeding control, transfusion requirement and overall mortality rate were collected. An analysis was performed on a subgroup of patients who presented with signs of associated severe hemodynamic shock, defined as ATLS III-IV upon admission and a requirement for blood products of more than 8IU in the first 48hours. Results A total of 567 patients with any type of pelvic fracture, between January 2011 and December 2018, identified in the institution's databases, of which 149 patients presented an unstable pelvic fracture pattern (FIP). 68.1% of the patients were male, with a mean age of 34 IQR; 30 years and an Injury Severity Score (ISS) of 34 IQR: 20. Hospital mortality was 13.3%. Angioembolization and external fixator placement were the most used method of bleeding control. A total of 37 patients (27%) underwent intervention to control bleeding in the first 48hours. There were 37 patients with pelvic fracture admitted in a state of severe shock or requiring more than 8U of blood products, 17 patients required intervention in the pelvis, using single or combined ways. The mortality calculated for these patients was 32%. Discussion Patients with unstable pelvis fractures admitted to our institution have a high mortality rate and it is even higher in patients who present with severe shock. Various methods were used to control bleeding similar to those indicated in the current literature. We require a sustained institutional effort to treat pelvic fractures and reduce the mortality of our patients, and knowing our population characteristcs allows us to guide management strategies.

Dengue shock syndrome with retroperitoneal haematoma requiring repeated artery angioembolization

A 53-year-old lady was admitted with decompensated dengue shock syndrome during the febrile phase, complicated by massive retroperitoneal bleeding requiring angioembolization. She was initially stabilized by fluid resuscitation at emergency department prior to ICU admission. While in ICU, her haemoglobin level plummeted from 17.5 g/dL to 5.8 g/dL without any obvious source of bleeding. She had hemodynamic instability and worsening acidosis. The abdominal ultrasound performed showed complex ascites and CT abdomen revealed a large right retroperitoneal hematoma with ongoing bleeding. The patient’s hemodynamic was restored and bleeding resolved after angioembolization of the right L2 lumbar artery and right phrenic artery.

Surgical treatment for patients with renal cell carcinoma and venous thrombosis / 中华泌尿外科杂志

Objective To investigate the efficacy and safety of radical nephrectomy associated with venous thrombectomy and the role of preoperative angioembolization.Methods From Sep 2006 to Dec 2014,the data from 15 cases with renal cell carcinoma and venous tumor thrombus were collected and analyzed retrospectively.The 15 patients included 8 men and 7 women,whose age ranged from 16 to 75 years.Before operation,all patients underwent imaging examinations which demonstrated the renal tumor and venous thrombus.The tumors size ranged from 5.4 to 14.5 cm.The levels of venous thrombus included 0 grade in 4 cases,Ⅰ grade in 2 cases,Ⅱ grade in 6 cases and Ⅲ grade in 3 cases.The 15 patients were divided into angioembolization group (n =5) and non-angioembolization group (n =10) according to the conduction of preoperative angioembolization.Results All cases successful accepted the nephrectomy.The venous thrombectomy were undergone in 14 cases except for one case due to the severe adhesion between renal vein and aorta.The average operative time was 243.3 ± 77.0 min.The mean blood loss was 1 373.3 ± 1 440.9 ml and the volume of blood transfusion was 533.3 ± 521.9 ml.The average time of postoperative hospital stay was 12.7 ± 5.2 days.Symptomatic tumor thrombus embolism didn't occur in all cases,perioperatively.There were no significant difference between these two groups in operative time,blood loss,blood transfusion volume and postoperative hospital stay (P ＞ 0.05).Eight cases were followed up with a period of 6 to 69 months.Four cases had disease-free survival during follow up.Two cases died at 30 and 55 months after surgery,respectively.One had tumor recurrence at 6 months after surgery.One patient accepted a 6-months target therapy (sunitinib) before surgery.However,his thrombus could not be removed during the operation.After the operation,he continued to choose the target drug therapy for 18 months.No progression for thrombosis or metastasis has been found.Conclusions Nephrectomy and venous thrombectomy could be safe and effective for renal cell carcinoma associated with venous thrombosis.Preoperative angioembolization could not reduce the perioperative risk such as blood loss.

Extension of Nonoperative Management on Spleen Injury with Judicious Selection and Embolization; 10 Years of Experience

PURPOSE: We describe clinical outcomes of NOM on spleen injuries with judicious selection and embolization during the past 10 years. METHODS: From March 2000 to November 2009, 151 patients with splenic injury were included. Eighteen patients were excluded because of incomplete data. Patients' medical records were reviewed to examine admission demographics, laboratory results, radiologic findings as well as transfusion requirement, hospital stay, and ultimate outcomes. RESULTS: Twenty patients were chosen for non-operative management (NOM) after splenic embolization and 1/20 (5%) patient failed. There were 32 patients more than 55 years old (range, 55~87 years). Of these patients, 26 (81%) patients were chosen for NOM and 3 (11.5%) patients failed. According to OIS, 51 patients were grade 3; 26 patients, grade 4; and 6 patients, grade 5. Among grade 3, 49 (96%) were chosen for NOM with or without embolization and 1 (2%) patient failed; grade 4, 19 (73%) with NOM, 2 (7.6%) patients failed. Of all 133 patients with NOM or failed NOM (FNOM), there was 0 mortality in grade 3; 2, in grade 4; 2, in grade 5, excluding other causes of death. The mean ISS was significantly higher in the failed NOM group compared with successful NOM group (P=0.01). The group of failed NOM had a significantly higher mean OIS (P=0.00). CONCLUSION: Aggressive but highly selective NOM on the base of clinicoradiologic parameters with the aid of angioembolization would result in a low failure rate and complication in the management of high grades (grade 3 or 4).

Use of Angioembolization to Replace Operative Management for Blunt Splenic Injury

PURPOSE: Over the past few decades, the treatment of traumatic splenic injuries has shifted to nonoperative management from surgical intervention. Although some nonoperative management failure have been reported, in most trauma centers, nonoperative management is now believed to be the treatment of choice in hemodynamically stable patients. Then, in this study, we have retrospectively evaluated our experience with traumatic splenic injury. METHODS: From January 2005 to July 2009, 150 patients with blunt splenic injuries were managed in our hospital. Patients' charts were retrospectively reviewed to analyze their treatment, the patients were grouped according to those who had been admitted before October 2006, defined as the "early group", and those who had been admitted after October 2006, defined as the "late group". After the patients had been divided into two group, physiologic parameters and differences between the treatments were compared. RESULTS: 150 patients were admitted to our hospital with blunt splenic trauma. In late group, both the surgical management rate and the nonoperative management failure rate were lower than they were in the early group. CONCLUSION: We expect angioembolization to effectively replace surgery for the treatment of selected patients with blunt splenic injury and to result in fewer complications.

Angioembolización selectiva: un valioso adyuvante en la estrategia de control de daños en heridas faciales por proyectil de arma de fuego: informe de un caso / Selective angioembolization: a valuable adjunct in damage control strategies applied to facial gunshot wounds: case report

Introducción: La angioembolización selectiva es una alternativa no quirúrgica para controlar el sangrado facial traumático. Caso clínico: Informamos el caso de un paciente con herida facial por proyectil de arma de fuego tratado con angioembolización selectiva como adyuvante al control de daños, con lo que se logró detener la hemorragia. Conclusiones: La angioembolización selectiva es un valioso adyuvante en la detención del sangrado facial traumático.

BACKGROUND: Selective angioembolization (SAE) is a nonsurgical alternative for controlling traumatic facial bleeding. CLINICAL CASE: We report a case of a patient who sustained a facial gunshot wound. The patient was treated with SAE as an adjuvant to damage control, leading to the arrest of hemorrhage. CONCLUSIONS: SAE is a valuable adjuvant in arresting traumatic facial bleeding.

Three Cases of Angioembolization in Renal Angiomyolipoma / 대한비뇨기과학회지

Renal angiomyolipomas are uncommon benign neoplasms composed of mature adipose tissue, thick walled blood vessels and smooth muscle in varying proportions. Accurate preoperative diagnosis of renal angiomyolipoma is essential if conservative resection or angiographic embolization is to be used. In recent years, abdominal computerized tomography (CT) and renal ultrasonography have resolved the diagnostic dilemma, making detection of angiomyolipomas possible in almost all cases. Recently, we performed selective renal angioembolizations in 3 patients (2 females, 1 male). After followup period of 6 months to 1 year, all patient got better in clinical symptoms. In two of them the lesions decreased in size on followup CT but one patient showed suspicious malignant change and we performed the exploration to rule out renal malignancy. In our opinion, it is appropriate to perform the selective renal angioembolization for initial treatment of renal angiomyolipomas.